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HomeMy WebLinkAbout017-180-011r �'; ' ;. BUTTE I.-FOUNTY • .' DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.netWds LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class : License Number: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation: of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of the Business and Professions Code /1 y Date:30 Y Owner: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued-, ❑ 1 have and will maintain workers' compensation insurance, as required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Policy #: PERMIT NO. BP040812 Issued Date: 04/02/2004 APN: 011-110-011-000 Site Address: 11782 BUTTE CREEK ISLAND RD CHI Map Index: I Description: RELOCATE MAIN SERVICE PANEL I Owner: MCJUNKIN LINDA C 11782 BUTTE CREEK ISL RD CHICO, CA 95928 Applicant: MCJUNKIN LINDA C 11782 BUTTE CREEK ISL RD CHICO, CA 95928 Contractor: License #: F Architect: i/J Engineer: Total Square Ft: 0 S.F. Valuation: $0.00 - - 111-1 certify that in the performance of the work for which this permit is Census Code: issued, I shall not employ any person in any manner so as to become subject to the workers" Compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 3 /.) 1// D '7 Applicant: AiiliC— WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one (-e c �� =j hundred thousand dollars ($100,000), in addition to the cost of I e L 59 Y o-7 compensation, .damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This I hereby affirm that there is a construction lending agency for the Res performance of the work for which this permit is issued (Sec 3097 Civ.) Name: By. PERMIT EXPIRES OFFICE COPY Address GAS Meter By Date ELECTRIC � ( n Meter By Date y been paid.v �J 4 1 nL�... �i/p/Oy O 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. thereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. 10� Print Name: ---M i- i< Trete �e- r—Signature Date: 3/X ZZ O V ❑ Owner ❑ Contractor B Agent for Owner ❑ Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 FAX#: (530)538-2140 WEBSITE: www.buttecounty.net\dds PERMIT NO. BP040812 LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Issued Date: 04/02/2004 APN: 011-110-011-000 the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Site Address: 11782 BUTTE CREEK ISLAND RD CHI Date: Contractor: Map Index: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Description: RELOCATE MAIN SERVICE PANEL Contractors' State License Law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior Owner: MCJUNKIN LINDA C to its issuance, also requires the applicant for such permit to file a 11782 BUTTE CREEK ISL RD signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 commencing with Section CHICO, CA 7000) of Division 3 of the Business and Professions Code) or that he or 95928 she is exempt therefrom and the basis for the alleged exemption. Any violation -of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an Applicant: MCJUNKIN LINDA C owner of property who builds or improves thereon, and who does 11782 BUTTE CREEK ISL RD such work himself or herself or through his or her own employees, CHICO, CA provided that such improvements are not intended or offered for sale. If however, the building or improvements are sold within one 95928 year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). l� I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, Contractor: and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ❑ 1 am Exempt under Article 3 of the Business and Professions Code L1 Date: Owner: License #: WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit Architect: is issued,, ❑ I have and will maintain workers' compensation insurance, as Engineer: required by Section 3700 the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier. Total Square Ft: 0 S. F. Policy u: Valuation: $0.00 51" 1 certify that in the performance of the work for which this permit is Census Code: issued, I shall not employ any person in any manner so as to become subject to the workers' -Compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 3 /.) y/0 41 Applicant: WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY This p unit s i d nd r the applicable provisions of the Butte Count Code nd/or 1 hereby affirm that there is a construction iending agency for the 6hreb Reso tie to o to or hich fqpsPave been paid. performance of the work for which this permit is issued (Sec 3097 Civ.) U Name: BY D te: PERMIT EXPIRES ON: 19 Date Address: ❑ 1 hereby certify that the use of this facility shall comply with Sections 25505, 25533, and 25534 of the California Health and Safety Code, which regulate the storage, handling and use of hazardous materials. ❑ Notification in accordance with Section 19827.5 of California Health & Safety Code is not applicable to the scheduled construction of this project. ❑ Attached are copies of the required E.P.A. notification forms. I hereby certify that I have read this application, that the above information is correct, and that I am the owner or the duly authorized agent of the owner. I agree to comply with all county and state laws relating to building construction. I acknowledge it is unlawful to alter the substance of any official form or document of Butte County. I hereby authorize representatives of Butte County to enter upon the above mentioned property for inspection purposes. Print Name:1 r o6- r- Signature: Date: _3// ), yZ O y ❑ Owner ❑ Contractor i2 Agent for Owner ❑ Agent for Contractor BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION 24 HOUR INSPECTION #: (530) 538-7636 (OROVILLE) (530) 891-2834 (CHICO) OFFICE #: (530) 538-7541 PERMIT NO. 0q- OYIZ B. C. Building Permit 01-23-04 pg 2 DATE: OLf APN: 0 I I - ZONING: NEA EST CROSS STREET: in A TRACT/LOT#: SITE ADDRESS: � e CITY, ZIP: � OWNER NAME: PHONE: ONE: — ri O.i G ! r1 STREET ADDRESS: FAX \ CITY, ZIP: 1 E-MAIL: APPLICANT NAME: PHONE: rl< � STREET ADDRESS: 3 14- n (1, FAX CITY, ZIP: C 1 E-MAIL: CONTRACTOR NAME: PHONE: STREET ADDRESS: -3 iA LIS FAX. CITY, ZIP: E-MAIL: 1 LICENSE NUMBER LICENSE TYPE: ARCHITECT/ENGINEER NAME: PHONE: STREET ADDRESS: FAX: CITY, ZIP: LICENSE NUMBER: E-MAIL: DESCRIPTION OR SCOPE OF WORK: If/ o Wlel FY14; � ❑ Structure Built without permits ❑ Proposed Change of Occupancy (note previous use) EXPIRATION OF APPLICATION Applications for which a permit has not been issued will expire one year after the date of application. In order to renew action on an application after expiration, a new application, plans and fees will be required. REQUEST FOR REFUNDS Refunds can only be made upon written request by the personid the fee. Th re t be made prior to the expiration of the permit and no construction work ha b don Filing fees . I for work plan checked and other de artment costs ar not refwta For office use only: Notes: Application Received by: Date: "D Receipt number: Amount Received: I I 0 . J B. C. Building Permit 01-23-04 pg 2 O.B.-1 OWNER -BUILDER VERIFICATION Attention Property Owner. An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit' will be issued until this verification is received. Q9I personally plan to provide the major Labor and materials for construction of the proposed Property improvement: YES ❑ NO [t- I HAVE ❑ HAVE NOT Bsigned an application for a building permit for the proposed work. I have contracted with the following person (firm) to provide the proposed construction: NAME: R n "S AIA CnC n W e AUL1t�5S:_ 3 1 .t 1-, r» ,: cL n CITY:_ P'1 i-, i c O S 9 3 PHONE: y. - : y S CONTRACTOR'S LICENSE NO. 4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and provide the major work NAME: ADDRESS: CITY: PHONE: CONTRACTOR'S LICENSE NO. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: NAME ADDRESS PHONE TYPE OF WORK SIGNED: PROPERTYOWNER: DATE: NOTE: This Owner -Builder Verifzc &n is required by Section 19831 and 19832 of the California Health and Safety Coda This verification must be completed and returned to our office before we are permitted to issue the permit OVER , OVNER BUILDER INFORMATION Dem -Property Owner. An application for a budding permit has been submitted in your name listing yourself as the budder of property ia�provemenis specified. For your protection, you should be aware that as "ownw4milder" you are the responsible party of record on such a psrimk Building pennhs are not required to be signed by property owners unless they are personally pertming their own.work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Conhuctm are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply: If you plan to do your own womb with the exception of various trades that you plan to subcontract, you should be aware of the following information far your benefit and protection: ♦ Ifyon employ or otherwise engage any persons other than your immediate family, and the work (Including materials and other costs) is 1300 or more for the entire pmject and such persons are not licensed as contractors or subeontactors, then yon may be an enmployer. ♦ If Y0u are an employer, you must register with the State and Federal Governments as an employer and you are subject to_ several obligations including stats and federal income tax withholding; federal somal security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks fur you if yon do not nary o t these obligations, and these risks are especially serious with resped to worker's compensation insurance, ♦ Formore specific iafannation aboutyour obligations under Federal Law, contract the Internal Revenue Service (and, if yon_ wish, the U.S. Small Bndnm Administration). For mare specific Mozmation about your obligations under Stade Law, coact tine Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their workjpersonally or dmigh their own employees, withourt a licensed contactor or subconhactor, only under limited con ions. Afrequent practice of unlit persons professing to be contractors is to secure an "owner budder" budding per, erroneously imps that the property owner is providing his or her own labor and material personally. Budding permits are not required to be signed by property owners unless they are performing their own work personally. In%a m about licensed coact ors may be obtained by contracting the Contractors State License Board in your eommnmity or at 1020 N Street; Sacramento, CA, 95814. Please complete the "Owner Builder Verification" on the reverse side of this form so that we can confirm that you t are aware of these matters. The building permit will not be issued until the verificaaion is retuned. I Y, C. V' na, C E.O. Building Inspection NOTE: TYxir Owner-BuHder IxforrneSan is required by Section 19830 ofBce CalCfornia Health and Safety Code 3/22/2004 I, Linda McJunkin, property owner at 11782 Butte Creek Island Road, Chico, CA, authorize Mark Trechter to act on my behalf to procure changes to electrical service on my property. Linda McJunkin COUNTY OF BUTTE -DEPARTMENT OF DEVELOPMENT SERVICES -BUILDING DIVISION 7 County Center Drive, Oroville, CA 95965 Phone (530)538-7541 Fax (530)538-2140 PERMIT APPLICATION DATA SHEET e bl�,-Ioil OWNER: � � � � I � �� � � ASSESSOR PARCEL NUM�HR )0 Proposed Building Use: rL i OC cL YVkCL',*/,l ✓-fV o wunter Technician:. PjT)ate: -Z v! / Items required in order to apply for a permit. All boxes MUST be checked OR marked NA in order to apply. ❑ 1. Site plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 2. Complete plans, 3 or 4 sets, signed by the preparer of the plans. ❑ 3. Engineered plans, 3 or 4 sets, with wet signature on plans AND 2 sets of stamped and signed calculations. ❑ 4. Engineered truss details and layouts in duplicate. No faxes! ❑ 5. Letter from Engineer or Architect for truss design review. ❑ 6. Energy compliance design and supporting documentation in duplicate. ❑ 7. Statement of Intent for Non -heated and A/C for Non -Residential Buildings. ❑ 8. Manufactured homes: (A) Data sheets and installation inst, (B) Marriage line info, (C) Floor Plan, (D) Tie down or fnd plans, all in duplicate. ❑ 9. Metal bldgs: (A) Metal Bldg Plans, (B) Find plans and calcs in triplicate, (C) Elevations in triplicate. (D) Floor plans in triplicate. All of these must be stamped and wet -signed by the engineer. ❑ 10. Flood Elevation Certificate, wet -stamped and signed, in duplicate ❑ 11. Site plan and business license approval from the City of Biggs ❑ 12. Letter of intent for non-residential buildings ❑ 13. Detached Accessory Building Form filled out by the owner ❑ 14. Hazardous Material Form ❑ 15. Sanitation and site plan approval from the Environmental Health Department in ❑ Chico ❑ Oroville, as applicable. ❑ 16. Other Remaining items needed to issue the permit. (May require additional plan review upon receipt of the following items.) ❑ 17. Fire Sprinklers............................................................................................ ❑ 18. Agricultural Buffer clr and site plan apr from the Ag Commissioner Sent by ❑ 19. Soils Report and/or Engineered Foundation required ........................................... ........ ❑ 20. Erosion Control Plan Required........................................................................ ........ ❑ 21. Fees as shown on the attached Schedule of Fees Due Sheet .............................. ❑ 22. City of Chico Plumbing permit........................................................................ ❑ 23. California Department of Forestry plan approval ❑ paid. Sent by: ............. ❑ 24. Planning approval (A) Use: (B)Parking: (C) Parcel Check: ❑ 25. Contact Land Development about _ Improvements, _ Drainage ......................... El26. NPDES Form............................................................................................. ❑ 27. Encroachment Permit for driveway from the Public Works Dept .......................... 19 28. Pre -Inspection for KC t O CC,+f V1,C1v_) OWLLrequired....... ❑ 29. Contractor's license information. (Number, Name Style, Classification) ................... ❑ 30. Worker's Compensation Carrier and Policy Number .................................... ...... ❑ 31. Owner -Builder Verification (_ Given to owner, _Mailed to owner) ..................... El 32. Letter of Signature authorization.................................................................... ❑ 33. Recorded copy of Agricultural Acknowledgment Statement ................................. ❑ 34. Manufactured home utility clearance............................................................... ❑ 35. Existing violations and/or expired permits......................................................... ❑ 36. Deed Restriction......................................................................................... ❑ 37. ❑ Grant Deed, ❑ M.H. Title/Statement of Facts, ❑ Letter from Legal Owner, 11Check to H.C.D. $ ❑ 38. Other: ❑ 39. Other: When issued Telephone 7 and hold for pickup. I have been informed of the a ove items and requirements for obtaining a building permit. Applicant: Date: 1. Index per it appl catio or the above items numbered: Plan Ched Letter 2. Additional items required Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Contractor, designer, owner, was advised of the above data by ❑ phone, ❑ mail, ❑ counter, by Date: Plans reviewed by: Date: Plans approved by: Date Structural reviewed by: Date: Structural approved by: Date: Note transfer by: Date: Yellow: Building Division PRE -INSPECTION REPORT OWNER: mc1zDATE: 0 LOCATION: Z CONTRACTOR: ZONING. PRE-INVETIONFOR. Q I OCt ,k 5'fJK✓ ►'Ce DATE TO JNSPECTOR �-'/ 2, 5 IO LJ PZRIW iILSTORY NE ( ) AS FOLLOWS: • BUILD�G lrI + Badldt g Deurlptim Retddeatial/+It a(Unks; Cwmdy Occupied eS Abeadoned/Vacaat Electric: Yes_ N Condition of Electric Gas: SI'ECTOR S RIrPORT Electric =Tently Oa Off Na —Propane, N Cmrrcntiy Ono% Off Obvious Problems. Sanitation: Plumbing Working (/1 r Well worldna t/. --C Obvious <>.,J - Potable water teS f w t? 1616 ACTION RECOMMENDED: ISSUE: HOLD FOR J Inspector: %l Date 3z - p Sketch buildings on reverse and indicate location on�o e p p rty.